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MED, SPH, and SSW partner in $1.5m program to advance drug treatment and prevention

By Hope Green

Although most physicians view substance abuse as an illness as much as cancer or heart disease, few are involved in its treatment. Too, drug abuse is not commonly covered as a topic in most residency and medical school programs.

	Maryann Amodeo Photo by Kalman Zabarsky

Yet studies increasingly point to the benefits of doctors taking an active role in addiction recovery. One who is leading by example is Jeffrey Samet, a MED associate professor of medicine and public health and a primary-care physician at Boston Medical Center.

When smokers, cocaine addicts, and alcoholics show up in the hospital's primary-care clinic, Samet doesn't just treat the complications of these symptoms; he addresses the problem behavior and may refer a patient to a rehabilitation center. Sometimes he helps move heroin addicts into a methadone program. As time passes and patients return for routine health care, he checks on their progress or counsels them if they have had a relapse.

Samet, who has been practicing for 18 years, would like to see more physicians learn how to detect and treat drug addiction problems. A new federal grant will help Boston University contribute exponentially to such training in the coming years.

Recently the National Institute on Drug Abuse (NIDA) awarded $1.5 million to Boston Medical Center and Boston University to create a program that will teach hospital-based physicians from around the country how to care for substance abusers. The Clinical Addiction Research and Education (CARE) program will be interdisciplinary, linking the fields of medicine, public health, and social work.

"We want to develop closer links between the hospital, the University, and community treatment agencies," says Samet. "We hope that by engaging physicians in conducting research and addressing the clinical needs of drug-abusing patients, we can reduce drug abuse."

Under the guidance of Samet, Maryann Amodeo, an associate professor and associate dean for academic affairs at BU's School of Social Work, and Daniel Alford, a MED clinical assistant professor, CARE will set out to achieve three goals. First, it will recruit and train physicians as drug-abuse specialists and support their independent research in drug-abuse prevention and treatment. The federal grant will fund two fellowships at the School of Public Health and a faculty position for physicians trained in internal, family, or emergency medicine.

A second component of the program, directed by Alford, will train 100 chief residents from across the country to screen and treat patients for drug abuse. Chief residents are new physicians who decide to continue their residencies for an additional year beyond the usual three years after medical school. They serve as mentors to those who are still completing their schooling and residency requirements.

"We saw this as an innovative mechanism by which we could disseminate a lot of alcohol- and drug-abuse education," says Samet.

CARE's third aim is to guide community-based organizations in adopting NIDA-recommended, science-based treatments for addiction. Amodeo, director of BU's Drug and Alcohol Institute, will work with four Boston-area agencies: Casa Esperanza for Latino Men and Women, the Center for Addictive Behaviors, Substance Abuse Treatment Services of the Boston Public Health Commission, and Victory Programs.

"The drug-treatment field is undergoing revolutionary change," she says. "NIDA has shown the effectiveness of new treatments and revived hope in treatments that were discarded because we couldn't tell what effect they were having.

"Unfortunately, these methods haven't reached line workers who are struggling each day to help multistressed clients, who often have serious difficulties beyond their addiction," Amodeo continues. "Finances prevent many agencies from pursuing a full range of professional training opportunities."

Samet and Amodeo already have worked together in training School of Medicine and School of Social Work faculty on drug prevention and treatment issues. But the new program goes farther, creating a national cadre of physicians with knowledge of the latest literature on treatment protocols and generating much more independent research. It also fosters greater collaboration between the schools. Samet and Alford, for example, will work with Amodeo to develop seminars and training materials for drug-abuse counselors at social service agencies. Amodeo will play an active role at annual chief resident training sessions.

Samet says it's important for physicians not only to look for signs of drug abuse, but to explain to patients exactly how drug and alcohol abuse can damage their health. He tells HIV patients who smoke that cigarettes have been shown to double the chances of contracting bacterial pneumonia for people infected with HIV. He reminds crack users that getting high can impair their judgment in intimate relationships, leading them to engage in unprotected sex, with the risk of contracting a sexually transmitted disease.
For patients in treatment programs who have suffered a relapse, Samet offers encouragement.

"These patients often feel very down on themselves because they know they've failed," he says. "You try to give them positive reinforcement, to get them to understand that they do have some control over their actions.
"It's really like talk therapy," says Samet. "But it's essential that we make these addiction issues central, because they're central to the patients' lives. If you don't recognize that, you're not going to be able to give the best care possible."

7 December 2001
Boston University
Office of University Relations